In my work with thousands of overstressed physicians and over 175 health care organizations, I have repeatedly learned one lesson: resilience training alone is not sufficient to rein in the epidemic of physician burnout.
If you believe, as I do, that physicians are the canary in the coal mine of medicine, then it is clear the epidemic of physician burnout is an indictment of the conditions of the mine, not the resilience of the canary. If you focus on physician resilience training and don’t de-stress the workplace at the same time, you are missing half the leverage points to prevent physician burnout. You are focused only on building a stronger canary and sending the message that every provider is on their own—no one has their back—on this job site.
I define resilience training as the acquisition of any burnout prevention tool the physician uses individually. The tool increases the physician’s resilience in the face of the stresses of their practice and workplace systems.
Training to promote physician resilience has value; however, that value is limited by the following three factors:
1. Resilience is a hostile concept for frontline caregivers. When you roll out “resilience training” to your people or tell them they need to be more resilient, here’s what the little voice in their head is saying: “Why? What are you going to do to me now?” It only increases everyone’s free-floating anxiety about what’s coming next.
2. Resilience training can actually increase physician burnout and physician leadership frustration. If you drop mandated physician resilience training on your people without giving them protected time to participate, you are increasing time demands and stress levels. They have no time, energy, or bandwidth for your new initiative. No matter how good your intentions are, trying to force them to attend another program they did not ask for will only make things worse.
Example of failure: You introduce a classic mindfulness-based stress relief training for your primary care physicians. You are concerned about burnout, and all the research shows that mindfulness helps with physician resilience. The class is three hours once a week, and a half-day silent meditation retreat is the final session. You make participation count for some citizenship points in the compensation formula and make it clear that you expect everyone to attend.
How would you expect your physicians to respond?
You would have minimal participation because of the time commitment. Those who do participate will find the extra burden a challenge and dropout rates will be high. Many providers will see this as just one more thing they have to fit into their week. For some, this will be the last straw.
As the leader, you will be extremely disappointed. You know your heart was in the right place, but you brought them a program you know will work, and they didn’t participate.
Remember that 50 percent of your providers are suffering from burnout today. The rest are walking that cliff edge. Your people are not sitting around with hours of free time, twiddling their thumbs, and waiting for your resilience program to come along.
You are asking them to contribute time and energy they don’t have—for a program they didn’t ask for. You are doing this TO your doctors, not WITH or FOR them.
Their failure to participate is not about you, your program, or even about them and their desires. This is a simple physics equation that obeys the first law of physician burnout: “You can’t give what you ain’t got.”
This is how well-intentioned physician resilience programs fail. But wait, there’s more. This failure can have other negative consequences.
Leaders must check their attitude here. If you try a couple of resilience programs with your physicians and they fail to participate, notice how you might start wondering, “What’s wrong with our doctors? We bring them programs to help, and they are not engaged.” This is the beginning of a toxic relationship between leadership and frontline providers.
Don’t let this happen to you.
The key is to ask the physicians what they want first. Don’t Lone Ranger this and try to figure out what to do for them. Just ask, and they will tell you what they want. When you provide the tools that match their desires, engagement, and participation are automatic.
3. Please remember that resilience is only necessary in a hostile environment. The only reason you are thinking about physician resilience in the first place is because the workplace is hostile to the health and well-being of your doctors. Remember that physician resilience is just one-half of a two-part equation.
If you don’t simultaneously improve the workplace systems, you are just building a stronger canary and stuffing her back in the very same coal mine day after day.
You are not alone here. All workplaces are hostile to the physician’s ability to spend an adequate amount of quality time with patients. This is a fundamental feature of the collision between patient care and documentation requirements taking place within any health care workplace. Most of the time, we try to ignore the challenge. We assume there is a promised land where the providers sail through the day with perfect patient satisfaction and all their charting is done only 30 minutes after the last patient leaves.
Resilience training alone won’t get you even close to this version of Nirvana.
Physician resilience training only works when it is part of a one-two punch. If you do provide physician resilience training, it is vitally important you follow with the second punch immediately. Your people need a continuous process to de-stress the workflow on behalf of the physicians and staff in the system.
You have a stronger canary; now build a better mine.
You must devote some portion of your leadership bandwidth to the continuous pursuit of quality improvement focused on helping your people get their work done with less stress and get home sooner.
This second step must follow your physician resilience training—ideally within three months—or you lose all impact and credibility.
Most organizations provide some form of physician resilience training:
- Physician burnout education
- Mindfulness training of some sort
- Finding Meaning in Medicine or other Balint-like support groups
… but they stop there.
The average health care employer will make changes to the workflow, but it is always in response to some outside mandate. ICD-10 and Meaningful Use are examples. What you don’t often see is a serious attempt to poll the physicians on their major stressors and work improvement plans to address their concerns.
The other shoe must drop here. The organization must play its role in de-stressing the workplace as soon as possible after your physician resilience training.
Dike Drummond is a Mayo-trained family practice physician, burnout survivor, executive coach, consultant, and founder of TheHappyMD.com. He teaches simple methods to help individual physicians and organizations recognize and prevent physician burnout. These tools were discovered and tested through Dr. Drummond’s 3,000+ hours of physician coaching experience. Since 2010, he has also delivered physician wellness training to over 40,000 doctors on behalf of 175 corporate and association clients on four continents. His current work is focused on the 7 Habits of Physician Wellbeing. Dr. Drummond has also trained 250 Physician Wellness Champions, and his Quadruple Aim Blueprint Corporate Physician Wellness Strategy is designed to launch all five components in a single onsite day. He can also be reached on Facebook, X @dikedrummond, and on his podcast, Physicians on Purpose.
